Mapping Spinal Cord Stimulation-Evoked Muscle Responses in Patients With Chronic Spinal Cord Injury

Brandon K. Hoglund, Claire A. Zurn, Lauren R. Madden, Caleb D Hoover, Julia Slopsema, David Y Balser, Ann Parr, Uzma Samadani, Matthew D. Johnson, Theoden I. Netoff, David P. Darrow

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: Epidural spinal cord stimulation (eSCS) has shown promise for restoring some volitional motor control after spinal cord injury (SCI). Maximizing therapeutic response requires effective spatial stimulation generated through careful configuration of anodes and cathodes on the eSCS lead. By exploring the way the spatial distribution of low frequency stimulation affects muscle activation patterns, we investigated the spatial specificity of stimulation-evoked responses for targeted muscle groups for restoration after chronic SCI (cSCI) in participants in the Epidural Stimulation After Neurologic Damage (E-STAND) trial. Materials and Methods: Fifteen participants with Abbreviated Injury Scale A cSCI from the E-STAND study were evaluated with a wide range of bipolar spatial patterns. Surface electromyography captured stimulation-evoked responses from the rectus abdominis (RA), intercostal, paraspinal, iliopsoas, rectus femoris (RF), tibialis anterior (TA), extensor hallucis longus (EHL), and gastrocnemius muscle groups bilaterally. Peak-to-peak amplitudes were analyzed for each pulse across muscles. Stimulation patterns with dipoles parallel (vertical configurations), perpendicular (horizontal configurations), and oblique (diagonal configurations) relative to the rostral-caudal axis were evaluated. Results: Cathodic stimulation in the transverse plane indicated ipsilaterally biased activation in RA, intercostal, paraspinal, iliopsoas, RF, TA, EHL, and gastrocnemius muscles (p < 0.05). We found that caudal cathodic stimulation was significantly more activating only in the RF and EHL muscle groups than in the rostral (p < 0.037 and p < 0.006, respectively). Oblique stimulation was found to be more activating in the RA, intercostal, paraspinal, iliopsoas, and TA muscle groups than in the transverse (p < 0.05). Conclusions: Cathodic stimulation provides uniform specificity for targeting laterality. Few muscle groups responded specifically to variation in rostral/caudal stimulation, and oblique stimulation improved stimulation responses when compared with horizontal configurations. These relations may enable tailored targeting of muscle groups, but the surprising amount of variation observed suggests that monitoring these evoked muscle responses will play a key role in this tailoring process. Clinical Trial Registration: The registration number for the study is NCT03026816.

Original languageEnglish (US)
Pages (from-to)1371-1380
Number of pages10
Issue number7
StatePublished - Oct 2023

Bibliographical note

Funding Information:
Source(s) of financial support: This work was supported by the Minnesota State Spinal Cord Injury and Traumatic Brain Injury Grant from the Minnesota Office of Higher Education . Devices are donated by Abbott/St Jude.

Publisher Copyright:
© 2022 International Neuromodulation Society


  • Electromyography
  • epidural spinal cord stimulation
  • spinal cord injury
  • spinal cord stimulation
  • volitional motor control

PubMed: MeSH publication types

  • Clinical Trial
  • Journal Article


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